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Volume 51, Number 2, April 2018

The impact of inoculum size on the activity of cefoperazone-sulbactam against multidrug resistant organisms 


Ping-Chin Chang, Chi-Chung Chen, Ying Chen Lu, Chih-Cheng Lai, Hui-Ling Huang, Yin-Ching Chuang, Hung-Jen Tang


 

Corresponding author:

Affiliations
Department of Health and Nutrition, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan
Correspondence
Corresponding author. Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan. Fax: +886 6 2832057. 



 

Background and purpose: 

This study aims to assess the in vitro activity of cefoperazone alone and different cefoperazone-sulbactam ratios against different inoculum sizes of multidrug resistant organisms.

 



 

Methods:

Minimum inhibitory concentrations (MICs) of cefoperazone, cefoperazone-sulbactam at fixed ratio of 1:1 and 2:1 against a normal inoculum size of 5 × 105 CFU/ml and a high inoculum size of 5 × 107 CFU/ml were measured. 



 

Results:

Each 33 isolates of extended-spectrum β-lactamases (ESBL)-producing Escherichia coli, ESBL-producing Klebsiella pneumoniae, carbapenem-resistant E. coli, and carbapenem-resistant Pseudomonas aeruginosa and a total of 122 isolates of carbapenem-resistant Acinetobacter baumannii were collected. After the addition of sulbactam at a 1:1 ratio, most MIC50 and MIC90 values decreased. Cefoperazone-sulbactam at a 1:1 ratio had a higher susceptibility rate against ESBL-producing E. coli, carbapenem-resistant E. coli, and carbapenem-resistant A. baumannii than cefoperazone-sulbactam at a 2:1 ratio (all P < 0.05). For ESBL-producing E. coli, the susceptibility rate of cefoperazone-sulbactam at ratios of (1:1) and (2:1) decreased from 97.0 to 87.9% and 90.9 to 60.6%, for normal to high inoculum, respectively. For ESBL-producing K. pneumoniae, both susceptibility rate of cefoperazone-sulbactam at ratios of (1:1) and (2:1) decreased from 75.8%, and 63.6% at normal inoculum to 51.5% and 42.4% at high inoculum. 



 

Conclusion:

Cefoperazone-sulbactam at a 1:1 ratio has greater in vitro activity against most multidrug resistant organisms than cefoperazone-sulbactam at a 2:1 ratio. Such combinations were not influenced by the inoculum size of ESBL-producing E. coli and K. pneumoniae and could be a therapeutic option for treating severe infections. 



 

Key words:

Cefoperazone-sulbactam, Extended-spectrum β-lactamases, Escherichia coli, Klebsiella pneumoniae, Inoculum size